HB4091 HB&I AM 2-13

HB4091 HB&I AM 2-13
The Committee on Banking & Insurance moves to amend the bill on page 1, after the enacting clause, after line 16, by striking the remainder of the bill and inserting in lieu thereof the following:
" That the Code of West Virginia, 1931, as amended, be amended, by adding thereto a new section, designated §5-16-7f; that said code be amended by adding thereto a new section, designated §5-16B- 6e; that said code be amended by adding thereto a new section, designated §33-15-22;that said code be amended by adding thereto a new section, designated §33 -16-18; and that said code be amended by adding thereto a new section, designated §33 -16D-17 , all to read as follows:
CHAPTER 5.

GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE AND ATTORNEY GENERAL;BOARD OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7f. Required coverage for autism spectrum disorder.
(a) Every policy of insurance or insurance plan provided for in the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the state of West Virginia shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:
(1) Every policy must provide full in-state or in-network coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out- of-state provider;
(2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six (26) years of age.
(3) Coverage for behavioral therapy may not exceed a seventy- five thousand dollar maximum benefit per year.
(4) Coverage shall be provided for up to four (4) visits, or consultations, with a certified Nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider;
(6) All prescription medications for autism spectrum disorder shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.
(c) For purposes of this section, "autism spectrum disorder" means one or more or a combination of the following neurobiological conditions: Autism, Asperger syndrome, Retts syndrome, or Pervasive Development Disorder.
Article 16B. WEST VIRGINIA CHILDREN'S HEALTH INSURANCE PROGRAM.
§5-16B-6e. Required coverage for autism spectrum disorder.
(a) Every plan for health services or accident and sickness insurance offered or provided pursuant to the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the state of West Virginia shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:
(1) The policy or plan must provide full in-state or in- network coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out- of-state provider;
(2) Coverage for behavioral therapy may not exceed a seventy- five thousand dollar maximum benefit per year.
(3) Coverage shall be provided for up to four (4) visits, or consultations, with a certified Nutritionist per year.
(4) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider;
(5) All prescription medications for autism spectrum disorder shall be covered by the plan or policy.
(7) The plan or policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.
(c) For purposes of this section, "autism spectrum disorder" means one or more or a combination of the following neurobiological conditions: Autism, Asperger syndrome, Retts syndrome, or Pervasive Development Disorder.
(d) The provisions of this section are not applicable to health care coverage provided by Medicaid.

CHAPTER 33.

INSURANCE

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-22. Required policy coverage for autism spectrum disorder.
(a) Every policy of insurance subject to the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the state of West Virginia shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:
(1) Every policy must provide full in-state or in-network coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out- of-state provider;
(2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six (26) years of age.
(3) Coverage for behavioral therapy may not exceed a seventy- five thousand dollar maximum benefit per year.
(4) Coverage shall be provided for up to four (4) visits, or consultations, with a certified Nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider;
(6) All prescription medications for autism spectrum disorder shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.
(c) For purposes of this section, "autism spectrum disorder" means one or more or a combination of the following neurobiological conditions: Autism, Asperger syndrome, Retts syndrome, or Pervasive Development Disorder.
(d) Notwithstanding any provision of this code to the contrary, this section, together with §5-16-7f, §5-16-6e, §33-16-18 and §33-16-17 shall be known as and may be collectively cited as "Cameron and Dominic's Law".
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-18. Required policy coverage for autism spectrum disorder.
(a) Every policy of insurance subject to the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the state of West Virginia shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:
(1) Every policy must provide full in-state or in-network coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out- of-state provider;
(2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six (26) years of age.
(3) Coverage for behavioral therapy may not exceed a seventy- five thousand dollar maximum benefit per year.
(4) Coverage shall be provided for up to four (4) visits, or consultations, with a certified Nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider;
(6) All prescription medications for autism spectrum disorder shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.
(c) For purposes of this section, "autism spectrum disorder" means one or more or a combination of the following neurobiological conditions: Autism, Asperger syndrome, Retts syndrome, or Pervasive Development Disorder.
ARTICLE 16D. MARKETING AND RATE PRACTICES FOR SMALL EMPLOYER ACCIDENT AND SICKNESS INSURANCE POLICIES.

§33-16D-17. Required policy coverage for autism spectrum disorder.

(a) Every policy of insurance subject to the provisions of this article which provides coverage for hospital, surgical, or medical care coverage in the state of West Virginia shall include full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, including all prevention, early detection, diagnosis and/or treatments and therapies that are approved by the Federal Drug Administration and shall meet the following requirements:
(1) Every policy must provide full in-state or in-network coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder notwithstanding that the insured is unable to receive a service, or treatment from an out- of-state provider;
(2) The benefits and coverage must be provided to any person diagnosed with autism spectrum disorder under twenty-six (26) years of age.
(3) Coverage for behavioral therapy may not exceed a seventy- five thousand dollar maximum benefit per year.
(4) Coverage shall be provided for up to four (4) visits, or consultations, with a certified Nutritionist per year.
(5) Treatment approved by the Federal Drug Administration for autism spectrum disorder will be covered by the policy when prescribed by a treating physician or health care provider;
(6) All prescription medications for autism spectrum disorder shall be covered by the policy.
(7) The policy shall cover medical evaluation and examination for early detection and diagnosis of autism spectrum disorder.
(c) For purposes of this section, "autism spectrum disorder" means one or more or a combination of the following neurobiological conditions: Autism, Asperger syndrome, Retts syndrome, or Pervasive Development Disorder."
Adopted
Rejected